Dr Azim and Partners

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed all 8 quality statements from this key question. Our rating for this key question is good. At our last comprehensive inspection in November 2022, we rated this key question as inadequate.

At this assessment, we found that the service was providing safe care, however there were areas where improvements could be made. The provider did not always adhere to best practice guidelines in the monitoring and administration of high-risk medicines, in particular, monitoring of patients prescribed Lithium and Benzodiazepines and Z-drugs. This issue had been identified in our follow up inspection on 4 April 2023 and remained an area for improvement. In addition, we received feedback following this assessment from the local care home that the practice provided services to. Concerns were raised about the practice’s responsiveness, delays in processing referrals, ensuring timely care and communication. We saw that the practice had made improvements to the management of long-term conditions, in particular, the management of patients with acute exacerbation of asthma.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice had a proactive and positive culture of safety, based on openness and honesty. Staff members were aware of practice policies regarding significant events, complaints and whistleblowing and were able to easily access these using the practice online system. Practice policies were discussed frequently at practice meetings and were discussed with new members of staff during the induction process. Practice meetings were held monthly and we saw evidence that complaints and significant events were standing agenda items at these meetings. We also saw evidence that a partner had given a talk for new staff members at a practice meeting regarding significant events. The reception and administrative team held meetings weekly and clinical meetings were held weekly. Staff who were unable to attend meetings were able to access the meeting minutes online.

The practice was able to demonstrate that concerns were listened to, investigated and that appropriate actions were taken. The practice maintained complaints and significant events logs which detailed a summary of the incident/ complaint, learning, actions to be taken as a result and any training provided subsequently. The logs were available online for staff to view. The practice provided an example of where negative feedback had been received a new protocol had been introduced to reduce the risk of documents being misplaced. Staff members we spoke with were aware of the process of raising significant events and had confidence that the concerns raised would be acted upon by management. The practice completed an annual review of complaints which analysed the trends in complaints and summarised actions taken to address these issues.

Patients were able to make complaints using an online form on the practice website and the practice had a complaints leaflet that was available at the surgery. The practice told us that it usually treated complaints as a significant event as it would provide a learning opportunity for all staff and embed good practice.

The practice had a referrals policy which outlined the process for staff to follow to ensure timely referrals and follow up. Staff members we spoke with understood their responsibilities to process routine referrals. Staff members also understood their responsibilities to process urgent cancer referrals and to follow these patients up by calling them to check if they had been seen or chase appointments if they had not been received. The practice had a system for the timely monitoring and processing of test results.

The practice worked with people and healthcare partners to ensure and maintain safe systems of care, in which safety was managed and monitored. The service worked with other care providers in the community to deliver shared can and when patients moved between services.

The practice delivered services to a local care home, which included weekly ward rounds for residents and additional visits for acutely unwell patients. We received feedback following this inspection that this process was not always working well, with concerns raised about the practice’s responsiveness, delays in processing referrals, ensuring timely care, and communication. The practice informed us that it had worked with the care home during a change in provider and had established communication and held meetings with the care home during the transition period to ensure continuity and a smooth handover of care. The practice had completed an audit on referrals which indicated that 90% of referrals were sent within one working day.

We found that patients with long-term conditions were appropriately monitored. During our clinical searches, we found no concerns in relation to the management of patients with acute exacerbation of asthma who were prescribed two or more courses of rescue steroids in the last 12 months and no issues with the monitoring of patients with chronic kidney disease (CKD). We reviewed patients with hypothyroidism who had not had thyroid function testing for 18 months and found that there were 2 patients. We discussed these patients with the GP partners during our inspection and were told that 1 patient had registered with a different GP prior to the assessment and was not being issued any medicine. The other patient had failed to attend scheduled monitoring appointments and their prescription had been reduced and subsequently discontinued. We found no issues with the management of patients with diabetes with a HbA1C over 74 mmol/l. The practice assured us that for patients who did not engage with monitoring, prescriptions would be reduced and then eventually stopped if the lack of engagement persisted.

Staff members that we spoke with demonstrated an understanding of the practice’s safeguarding policies and were confident in the method of escalation if a safeguarding incident arose. Staff members were able to access the safeguarding policies. The practice held adult and children safeguarding registers which were reviewed on a regular basis. We saw evidence that the registers and safeguarding were routinely discussed in practice meetings. The practice provided us with an example of how it had managed a recent safeguarding concern, where it had appropriately escalated and liaised with healthcare partners. The practice had a process for managing cases that were the subject of case conferences and worked in partnership with other organisations such as the local safeguarding board. Clinical staff told us about the process for monitoring patients potentially at risk of Female Genital Mutilation (FGM) and escalation of risks.

The practice manager had oversight of staff training. Staff had mostly completed the appropriate adult and child safeguarding training for their role. We noted that some non-clinical members of staff had completed level 1 of child safeguarding training. Following our inspection we were assured by the practice that the safeguarding requirements for reception and administrative staff had been updated and that these members of staff had now completed level 2 of child safeguarding training. Staff members had completed specialist training in relation to domestic violence and abuse.

Results from the national GP Patient Survey for questions relating to patients being involved in decisions about their care and treatment showed that the practice was not achieving the expected benchmark in relation to this quality statement. A total of 123 surveys were completed by patients which was a completion rate of 21%.

We saw evidence that staff understood their role in involving people in making decisions about their care and treatment. Risks were identified and discussion with people and documented in patient records such as do not attempt cardiovascular resuscitation (DNACPR) decisions.

We saw evidence of patients being involved in the management of their long-term conditions and were given opportunities to choose different ways to manage their health. The practice told us that it worked with people to understand and manage risks and treat the patient individually and holistically. The practice signposted patients to services where required, including to the Primary Care Network (PCN) mental health practitioner and wellbeing coach. The practice would send information to patients with anxiety and depression with information about the wellbeing hub and counselling facilities. The practice told us it had a large population of asylum seekers and refugees and it would assist these patients to access services. The practice clinicians spoke 10 different languages and the practice utilised translation services where it could not provide an interpreter for a patient.

The practice was equipped to respond to medical emergencies, included suspected sepsis and staff were trained in emergency procedures. The practice held annual talks on sepsis to ensure that staff were familiar with the most recent guidelines. Staff members we spoke with were aware of what action to take in the event of a medical emergency and were aware of how to escalate concerns and raise an alarm.

The service detected and controlled potential risks in the care environment. It made sure that equipment, facilities and technology supported the delivery of safe care. We observed the premises was well maintained and there were systems in placed to ensure equipment was safe. We found there were up to date fire, health and safety and Legionella risk assessments with action plans completed by the practice following these assessments. There was evidence the surgery had systems for safely managing healthcare waste. Staff had completed the appropriate fire and health and safety training. The practice had a personal and general emergency evacuation plan policy, fire safety policy and fire marshal warden guidance which was available for all staff to view on Teams. The practice had a business continuity plan and staff members we spoke with were aware of how and where to access this.

We reviewed files for two clinical and two non-clinical members of staff. We found that staff records were well managed with the required employment checks completed, in line with the practice’s HR protocol and recruitment policy and procedure. The practice had a process for managing and monitoring staff development and a staff development policy which outlined the training requirements for all staff. The practice manager was responsible for the overseeing of staff inductions and staff training. The practice manager raised any training due to be completed by staff members with them and discussed this with them during informal chats and appraisals. The practice supported staff in their development, for example, it facilitated a member of reception staff to complete phlebotomy training, another member of staff to train to be a reception supervisor and another member of staff to train in prescription management. The practice manager was in the process of completing a healthcare management qualification. Staff members told us that they were given protected time to complete training and felt comfortable in discussing their training requirements, aspirations and career progression with management. The practice procured an external human resources service which it could refer to where required for advice.

The practice had a performance appraisal policy and procedure and appraisals were held with staff annually in line with this policy. The practice conducted 3 and 6 month reviews for new staff members. The GP partners supervised the PCN pharmacists working with the practice by conducting regular audits of prescribing, including prescribing for asthma patients by the nurse. Case based discussions were held with the practice nurse. A GP partner was working with the pharmacists to ensure that they did not work outside of their remit.

The GP partners told us the practice had found it challenging to recruit GPs but that 3 had recently been recruited to start later in the year. The practice told us the aim was to develop and consolidate the stable team that was in place, putting patient care at the centre of everything. The practice currently utilised the services of a bank of locum GPs who were familiar with the practice to ensure consistency. All locums had access to the practice policies on Teams and a locum pack. The GP partners regularly had sessions at the practice and were always contactable by staff members if required. Staff we spoke with told us that they felt that the level of staff was sufficient to meet the needs of the practice population, with the assistance of locum GPs.

The practice ensured it monitored the competency of PCN staff members, for example the PCN pharmacists, by supervising and auditing their work.

The practice assessed and managed the risk of infection. When we visited the practice, we found the surgery had the appropriate standards of cleanliness and hygiene, however, we provided feedback to the practice that it should liaise with its cleaning contractor to tidy the cleaning cupboard and clean the lower sink. The cleaning cupboard was not accessible to members of the public.

The practice nurse was the designated lead for infection prevention and control (IPC) and staff had completed the relevant training. The practice had an infection control policy which staff were able to access centrally on Teams. We saw evidence the practice completed monthly and annual IPC audits. The practice nurse completed hand hygiene and personal protective equipment training for new members of staff and we saw evidence that IPC was discussed in practice meetings as a regular agenda item.

We saw evidence staff vaccinations were up to date in line with UK Health Security Agency (UKHSA) guidance, with risk assessments completed where staff had declined vaccination.

The practice had a policy for cold chain management and a process in place for the checking and monitoring of fridge temperatures and contents. When we were on site, we found some missing months from the log book for the checking of child and adult vaccinations. The practice subsequently provided us with this information. We saw evidence the practice had logged a significant event in July 2024 where the fridge temperature was above parameters due to a power failure. This incident had been discussed in the practice meeting and a plan had been put in place to download information from the data logger in the fridge on a weekly basis.

We carried out remote clinical searches of patient records as part of our assessment to review if the practice was assessing and delivering care and treatment in line with current legislation, standards and evidence-based guidance. We noted the practice had a medicines management policy, however, monitoring was not always consistent with this policy. We found that in most cases, patient received appropriate monitoring at the required intervals. The practice told us if a patient’s blood test monitoring was overdue, their prescription would be reduced or stopped until monitoring had been completed. The practice held regular meetings with PCN pharmacists about prescribing high-risk medicines.

We found some concerns in relation to the monitoring and prescribing of some high-risk medicines. In particular, we reviewed patients prescribed Lithium (medicine used to treat mood disorders) in our clinical searches and found 4 patients prescribed this medicine. Of these 4 patients, 2 were identified as having outstanding monitoring. We reviewed these patients and were told by the practice that it had been in touch with 1 patient to arrange blood testing and the other patient had the calcium level omitted from their blood testing. The practice told us it would discuss this with the pharmacy team and the calcium level would need to be required in future monitoring.

At our follow up inspection on 4 May 2023, we identified issues in relation to the management of patients prescribed Benzodiazepines and Z drugs. We found this issue remained a concern during this assessment. We reviewed patients prescribed over 10 prescriptions of Benzodiazepines (medicines indicated for the short term relief of anxiety that is severe, disabling or causing the patient unacceptable distress) and Z-drugs (medicines indicated for the short term management of insomnia in adults in situations where the insomnia is debilitating or causing severe distress for the patient) in our clinical searches. We identified 31 patients and reviewed 5 of these patients. We discussed the management of 2 of these patients with the GP partners. 1 patient was on a combination of medicines and there was high usage of this medicine. We provided feedback that this was of concern and that a clear reduction plan should be put in place and implemented. The second patient was elderly and was at risk of falls. We provided feedback that this patient should continue to be reviewed and that a reduction plan should be put in place and implemented. We could not be assured the practice approach was consistent and that there were effective systems and processes for the monitoring of over usage of these medicines. We were assured by the practice that it would review all patients identified.

Following our assessment, the practice told us that the first patient had a clinical plan to reduce and discontinue the medicine, due to the high risk of severe withdrawal and destabilisation if both medicines were tapered simultaneously. The practice told us that this decision reflected a careful and evidence based approach to minimise harm and ensure patient safety. The practice informed us that it had discussed the possibility of reduction of the medicine with the second patient and that the patient had declined. The practice told us that with both of these patients, there had been a clear focus on clinical safety, harm reduction and patient involvement.

We found the practice had an effective system in place to implement patient safety alerts. We reviewed a Medicines and Healthcare Products Regulatory Agency (MHRA) alert relating to the prescribing of the combination of Esomeprazole (medicine used to lower stomach acid) and Clopidogrel (an antiplatelet medicine that reduces the risk of blood clots forming). We identified 1 patient on this combination of medicines and saw there had been an appropriate discussion with this patient about risks and this patient had declined a transfer from these medicines. The practice maintained a log of all MHRA alerts and these were routinely discussed at practice meetings.

During our site visit, we observed the system for monitoring emergency medicines and emergency equipment and vaccinations was effective overall. Emergency medicines and vaccinations we looked at were all in date and well organised. We found two items of supplies had expired and the practice removed these immediately. The practice provided us with a risk assessment which detailed the emergency medicines which were not held by the practice and provided justification for this. Blank prescriptions were stored securely, monitored and audited appropriately to ensure continued security.